Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Oral Oncol. 2020 Dec;111:104940. doi: 10.1016/j.oraloncology.2020.104940. Epub 2020 Aug 5.
Depth of invasion (DOI) is the most important predictor for lymph node metastasis (LNM) in early stage (T1-T2) oral cancer. The aim of this study is to validate the cut-off value of 4 mm on which the decision to perform an Elective Neck Dissection (END) is made.
We performed a retrospective study in patients with pathologically proven early stage oral cavity squamous cell carcinoma (OCSCC) without clinical or radiological signs of LNM, who were treated between 2013 and 2018. An END was performed when DOI was ≥ 4 mm and a watchful waiting protocol was applied in patients with DOI < 4 mm.
Three hundred patients were included. END was performed in 77% of patients with DOI ≥ 4 mm, of which 36% had occult LNM (pN+). Patients in the watchful waiting group (48%) developed a regional recurrence in 5.2% for DOI < 4 mm and 24.1% for DOI ≥ 4 mm. For DOI ≥ 4 mm, regional recurrence free survival was higher for patients who were treated with END compared to watchful waiting (p = 0.002). A Receiver-Operator-Curve -analysis showed that a DOI cut-off value of 4.0 mm was the optimal threshold for the prediction of occult LNM (95.1% sensitivity, 52.9% specificity).
A DOI of ≥ 4 mm is an accurate cut-off value for performing an END in early stage OCSCC. END results in higher survival rates and lower regional recurrence rates in patients with DOI ≥ 4 mm.
侵袭深度（DOI）是预测早期（T1-T2）口腔癌淋巴结转移（LNM）的最重要指标。本研究旨在验证 4mm 作为决定是否行选择性颈部清扫术（END）的截断值。
我们对 2013 年至 2018 年间经病理证实的无 LNM 临床或影像学征象的早期口腔鳞状细胞癌（OCSCC）患者进行了回顾性研究。当 DOI≥4mm 时行 END，DOI<4mm 时采用密切观察等待方案。
共纳入 300 例患者。DOI≥4mm 的患者中有 77%行 END，其中 36%为隐匿性 LNM（pN+）。DOI<4mm 的密切观察等待组（48%）中，5.2%发生局部区域复发，DOI≥4mm 的患者中，24.1%发生局部区域复发。对于 DOI≥4mm 的患者，与密切观察等待相比，行 END 治疗的患者局部区域无复发生存率更高（p=0.002）。ROC 曲线分析显示，DOI 截断值为 4.0mm 时，预测隐匿性 LNM 的最佳阈值为 95.1%的敏感性和 52.9%的特异性。
DOI≥4mm 是行早期 OCSCC END 的准确截断值。对于 DOI≥4mm 的患者，END 可提高生存率，降低局部区域复发率。
